We then discussed the natural course of HIV

We then discussed the natural course of HIV disease and I explained to him that with good medical care I was confident that he would do very well with his infection. I also told him that I anticipated that he would remain free of any AIDS-defining complications for decades. Although he was pleased to hear this, he was surprised and initially not convinced. He believed that HIV infection and AIDS were essentially the same and that it was only a matter of months to a few years before he would be ill. --- Misconception #2. I explained to him that the average time from the initial infection to the onset of symptoms of AIDS in those who do not have access to HIV drugs (antiretroviral therapy) is estimated to be 8 to 10 years. With treatment that is appropriately followed, it is conceivable, and frankly expected on my part, that he could remain healthy for years to decades beyond this period. Finally, we discussed the potential role of antiretroviral therapy. He told me that he believed that therapy would require taking dozens of pills a day and that he would suffer many side-effects. He also thought that treatment would need to be initiated as soon as possible. --- Misconception #3. I summarized for him how the HIV viral load and CD4 cell numbers are monitored in deciding when therapy should be started and that many people can defer therapy for years. Moreover, we discussed that there are currently 15 approved drugs that are used in 3 or 4 drug combinations, many of which require taking as few as 1 to 6 pills twice per day. In addition, I explained the types of side effects that might be expected and the fact that with the many options available, most people can find a regimen that is tolerable. By the time this patient left my office, he realized that while the diagnosis of HIV will forevermore be a part of his life, it was a part that he was going to be able to live with. This is the first step in dealing with the psychological trauma associated with this diagnosis.

A second patient I met approximately 12 months ago was a 33 year old heterosexual female who had no history of intravenous drug use and had only had sex with 3 men in her entire life. As far as she knew none of them were bi-sexual or used intravenous drugs. I met her when she was in the hospital after having been admitted with pneumonia that failed to respond to routine antibiotics. She ultimately underwent a bronchoscopy and was found to have Pneumocystis carinii pneumonia. Subsequent HIV testing was found to be positive and her CD4 cell count was measured at 20 cells/uL. She too was devastated by the diagnosis and perplexed as to how she acquired the infection. I explained to her that in all likelihood, it was from one of her previous partners and that she probably became infected many years ago since it would have taken on average 8 to 10 years for the disease to have progressed to her current stage of immune suppression (represented by the significantly low CD4 count). Furthermore, I told her that heterosexual women represented one of the fastest growing groups of newly infected individuals.